<%--
    Document   : register
    Created on : 11 Okt 11, 1:20:25
    Author     : Laili :D
--%>

<%@page contentType="text/html" pageEncoding="UTF-8"%>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   "http://www.w3.org/TR/html4/loose.dtd">

<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title>Form Registrasi</title>
    </head>
    <body>
        <h2>Form Registrasi</h2>
        <br>
        <form method="post" action="registrasi">
            <fieldset>
                Username :
                <input type="text" name="userName" />
                <br><br>
                Nama Lengkap :
                <input type="text" name="namaLengkap" />
                <br><br>
                Email :
                <input type="text" name="email" />
                <br><br>
                 <tr>
                    <td>Jenis Kelamin :</td>
                    <td><input type=radio 
                               name=jenisKelamin value=Laki-laki checked>L
                        <input type=radio
                               name=jenisKelamin value=Perempuan>P </td>
                </tr>
                <br><br>
                Password :
                <input type="password" name="pass" />
                <br><br>
                Umur :
                <input type="text" name="umur" />
                <br><br>
                 <tr>
                    <td>Kadar Gula :</td>
                    <td>
                        <select name=kadarGula>
                            <option value="80-300" >80-300 mg/dl
                                </option>
                            <option value="70-80" >60-70 kg
                                </option>
                            <option value="80-100">80-100 kg
                                </option>
                            <option value=">100"> >100 kg
                                </option>
                        </select>
                    </td>
                </tr>
                <br><br>
               <tr>
                    <td>Berat Badan :</td>
                    <td>
                        <select name=beratBadan>
                            <option value="50-70" >50-60 kg
                                </option>
                            <option value="70-80" >60-70 kg
                                </option>
                            <option value="80-100">80-100 kg
                                </option>
                            <option value=">100"> > 100 kg
                                </option>
                        </select>
                    </td>
                </tr>
                <br><br>
                  <tr>
                    <td>Lama Sakit :</td>
                    <td>
                        <select name=lamaSakit>
                            <option value="1-2" > 1 - 2 tahun
                                </option>
                            <option value="2-4" > 2 - 4 tahun
                                </option>
                            <option value="4-6"> 4 - 6 tahun
                                </option>
                            <option value=">4"> > 4 tahun
                            </option>
                        </select>
                    </td>
                </tr>
                <br><br>
                Catatan :
                <input type="text" name="catatan" />
                <br><br>
               
                <input type="submit" value="Registrasi" />
            </fieldset>
        </form>
    </body>
</html>
